During a federal court hearing in July, a string of witnesses accused the state of altering or destroying medical records, using so-called "dry cells" and shuffling prisoners to deny them access to court-ordered investigators.

"Attempts to mislead the Court strike at the heart of the judicial process," wrote Carter.

Deep in the judicial order—on Page 18 of the 19-page document—was perhaps the most stunning passage in Carter's ruling:

"Defendant [Idaho Department of Correction] shall have the burden to prove that there are no ongoing constitutional violations, that the relief ordered exceeds what is necessary to correct an ongoing constitutional violation." In other words, IDOC has the burden of proof moving forward in the now-decades-old Balla vs. Idaho lawsuit, which alleged inadequate and inappropriate medical care.

"That's really huge and quite frankly, the single-most important part of Carter's ruling," said Boise attorney Andrew Schoppe. "The Department of Correction might have an impossible task. They've got to work crazy hard to show the court that they've rectified and remedied all of the constitutional issues."

During the federal case, Canfield and other former clinicians said they saw prisoners' medical records altered or even scrubbed by IDOC superiors. What's more, dry cells—called "barbaric" by a court-ordered investigator—were found to have been used regularly at ISCI but were mysteriously empty when investigators audited the prison.

"The judge's ruling has demonstrated once again that IDOC has indeed allowed corruption and misuse of power to deny basic human rights to incarcerated people," Canfield told Boise Weekly following Carter's ruling. "This is a victory for all the brave people who risked retaliation for telling the truth, and ultimately for the integrity for the state of Idaho."

In essence, Carter told IDOC it must reset the clock for a new round of court-ordered investigations. In page-after-page of the ruling, Carter wrote he believed the "consistency and credibility" of the mounds of evidence against IDOC and it had "crossed the line" in its attempts to manipulate previous investigations.

"Honestly, I think going forward, we're going to see more eruptions of bad news coming from the prison, probably more than ever," said Schoppe. "Keep in mind that before this, the court presumed that IDOC was following the rules. Going forward, the court is forever going to be skeptical. I don't see this going well for them. Where there's smoke, there's fire."

For his part, Kevin Kempf, the Director of IDOC, insists the wrongdoings are in the past.

"Please know this," Kempf wrote in a response to the ruling. "The actions that Judge Carter ruled IDOC took with improper purpose occurred in 2011 and 2012. We now have new people and new policies in place.

"We have nothing to hide," he wrote, adding he was disappointed the Balla case—which in 2012 found IDOC had not provided adequate health care for prisoners—will continue. "But I remain determined to bring it to a close."

Schoppe said a number of people still working for Kempf were in positions of power during the worst of IDOC's troubles—a fact confirmed by Carter.

"The few people mentioned in Carter's ruling couldn't have done this alone. In fact, we know for a fact that prior complaints had risen to the top," said Schoppe. "But they did nothing to change things. Well, they're going to need to change their culture now, in a big way."